How to do an eligibility screening- Case Manager- Karisha

When a case manager goes into the home (after receiving a referral and on all visits) they are checking to see if the client is still eligible. A lot of what you learn in your biology, sociology and psychology classes comes in handy for your assessment of the client. Going through the gerontology program allows you to analyze the client on a different level than someone with out your extensive background.
Here is an Eligibility Screen check list:
INFORMATION TO INCLUDE
• DATE
• Reason for visit
• Travel

S.O.A.P.S – SUBJECTIVE
What the client says
Ex: I have been fine and do my own bathing and meal preparation

O – OBJECTIVEWhat you see (appearance, cleanliness, visually, smell…)
Ex: The client does not look like she has bathed in weeks, there is food on her clothes and the countertops and tables are cluttered with paper, food and bills.

A – ASSESSMENTFacts
Ex: The client is in a wheelchair and can not bend to clean the kitchen floor

P – PLANWhat the case manger is going to do about it
Ex: The case manager may suggest homemaker, personal attendant and bill payer assistance

Back up Plan – 911

CCB:
• Call Provider and check PA hours
• Call Provider and have them fax 485 orders for their PA
• Call Provider and check number of hours being provided

Here is an example of how you will be thinking

Problem:
87 year old, female diagnosed with

Goal:
Provide case management to monitor and assess ongoing services
Care being provided
Ex: continue respite care for 12 hrs for ______

Objective:
To keep client at home in a safe and feasible home environment and as independent as possible

What to do when ? Case Manager- Karisha

I spend my day either visiting clients in their homes or at my desk typing up the notes about the visit.

This is the process in how the clients obtain services and keep them updated.

1. Referral from client
(call in or in person)
2. Referral directed to Supervisor
(depending on the service projected to receive)
3. Case manager is assigned referral

Client’s needs are going to determine the steps to follow first
A. Referral – stay in home transition- NH, hospital to bring home

B. On Medicaid Not on Medicaid

1. Phone: Call client to see if they are interested in services
2. Home visit
a. Assessment
b. Eligibility Screen (Will post details later)
c. Application (Medicaid)
d. Application for LTC services Check list of client needs
e. Doctors certification 450B
3. Provider list (client chooses who they want to provide them with the services they need )

Follow up with Client:
1. Quarterly
2. 60 day Assessment
3. Quarterly
4. Annual (reassessment)

That is the basics of how the case manager and the client work together. We see each other every 90 days. I have around 60 clients right now so I go on at least 5-10 home visits a week and then do extensive write-ups to the state to justify that they still quality for services.
Obviously, the home visits are my favorite part vs. the documentation.

Case manager Karisha shows a bathroom modification

Can you detect all the changes?

This is an example of what a bathroom modification would look like to meet a clients needs. This is a typical modification for a client that is frail. I switched out the tub for a roll in shower, rearranged the sink and widened the doorway to accommodate the walker currently using and wheelchair in the future. Also, non slip floors were added and grab bars on the toilet. Each house is unique and usually does not have a lot of space to work with. Also, each clients need is unique. One client may not be able to use their left arm and will need extra grab bars that would be used by their right arm only.
Another example would be someone who is a total assist (can not use a their arms or legs to use a bathroom) and so they would never use a grab bar but would utilize a ceiling lift.
As I said before the modifications are my favorite part of my job. The design is based on the clients needs so your gerontological knowledge comes in real handy. The products are endless but the budget is not so you have to be thrifty in reusing supplies if you can and picking out products that stick to the budget.

A Typical Work Day for Joanna

As an Engage Life Director, I plan all sorts of programs and activities for residents at Atria Merrimack Place and have three assistants as well as some volunteers to help me! My main responsibility is to plan each monthly activity/event calendar two months in advance in order to ensure I can get colored copies of my calendar printed and delivered to my building prior to the actual month beginning. For example, on April 1st, I will be starting to solidify and confirm all the activities/events/programs (as well as my personal and staff schedule/work hours) for the month of June! Planning this far in advance was a little challenging for me to do at first, but now it's just second nature. To see one of my most recent monthly calendars, go to my community's website and click on "Community Calendar" on the right side: http://www.atriaseniorliving.com/community.aspx?id=1590

This is a job where I (as well as my staff) do not spend most of my (our) time sitting in an office staring at a computer and answering/receiving phone calls and e-mails. Instead, I get to wear many different hats: department manager, exercise instructor, bar tender/waitress, educator, art teacher, photographer, videographer, van driver, counselor, decorator, gardener, computer technician, receptionist, dancer, caregiver, shopper, event planner, tour guide, etc. It's nice because to me my job is fun, rewarding, and dynamic. No day of the week is ever the same. I can honestly say that I never get bored when I'm at work. My building always has activities going on, even on weekends and evenings. My staff and I rotate working the weekends. Being flexible with my work schedule is an important and helpful aspect with this type of work, as special events/parties and emergencies do arise. Emergencies include power outages, floods, fires, evacuations, etc. Sometimes, my staff and I end up helping our other "sister" Atria communities with transportation (we have a 14-seat van) when they experience emergencies.

Below is an example of a typical activity schedule for one day:
9:30 Exercise Class: Weights!
10:00 Play Wii Tennis
10:00 Board Game with Adam
10:15 Shopping Trip: Walmart in NH
11:00 Word Game
11:00 Choral Group
10:30 Store Cart
11:30 & 12:45 Dinner
1:30 Bridge Group
1:45 Communion & Rosary w/ Joe
2:30 Scott Entertains: Piano & Singing!
3:15 Happy Hour
4:15 Trivia
4:30 & 5:45 Supper
6:45 Evening Fireside Chat
7:00 Movie Night
7:00 Card Games

It's important to note that my staff and I are the ones responsible for both setting up and cleaning up all of the activities listed above. And, more importantly, to make sure the activities start on time!! (If you want happy seniors, then you must always start on time, otherwise you may be sorry!) Sometimes it is necessary for my staff and I to remind some residents about events or even recruit residents in order to promote a specific or new activity. Whenever there's a new resident, I take the time to interview them in order to get to know their history and interest/recreation background. Then, I have to see if we currently offer activities/programs that meet this resident's interests, and if we do not, then I have to think creatively and make sure this happens. I need to make sure that there is something for everyone, so our residents can be happily engaged in life at our community.

Introduction from Joanna

Interestingly, I found my way into the field of aging via psychology. I had a very good and inspirational psychology/behavior science teacher in high school who motivated me to start out as a psychology major in college. Because psychology is such a big field, I wanted to narrow it down to at least the population that I wanted to work with. I read a few books about careers in psychology and that's when I read about the Gerontologist. Right away I knew this was it for me! Soon after this discovery, I decided to change my major to Gerontology since I wanted to focus on aging and my other interests related to aging. Of course, having close relationships with all four of my grandparents also strongly influenced and encouraged me to study aging more in depth. I also realized that studying aging is very beneficial since we all age, and understanding it will only help us to better understand ourselves, others, and life in general. (Not to mention there are all those Baby Boomers--my parents' generations--who are retiring and becoming grandparents!)

In May 2007, I graduated from Ithaca College with a B.S. in Gerontology and a Minor in Recreation. I chose Recreation as my minor since my major interest in the field of aging was quality of life and how we are able to improve the quality of life for seniors. After college, I decided to take a break from academics and get some work experience in the field of aging and recreation. So, for the past 2 and a half years I've been working for Atria Senior Living Group, a privately owned assisted living company that has nearly 130 communities located all over the United States. I work at Atria Merrimack Place in Newburyport, MA as the Engage Life Director. This is the same thing as an activity or recreation director. My company chose to call the "recreation" department "Engage Life" because that is exactly what my staff and I do everyday: continually devise and promote a variety of recreational programs in order to keep our senior residents happy, physically and mentally active, and to put it simply, engaged in life! My building has 3 levels of care: independent, assisted living, and Life Guidance (Alzheimer's care). So, it is similar to a CCRC; however, the main difference is that we do not provide nursing care.

Whenever I tell people about my Gerontology B.S. or that I work with seniors, 9 times out of 10 these people automatically tell me, "Well....that must be somewhat depressing, huh?" I simply smile back and say, "Not at all!" Just think of all those seniors I surround myself with and interact with on a daily basis, and if practice makes perfect, then this means I have the great pleasure of spending my 40-hour work week with people who have had the opportunity to develop their sense of humor for over 70, 80, 90+ years! But most people don't think about things like this....do you?

I never knew what a unit was for case manager

I have mentioned this a little bit in the other posts but I never really knew what a unit was until I became a case manager. Everything and I mean everything we do has to be put in as a unit so that we can bill and get reimbursed for our work. See below how the units are designated into 15 minute time blocks. In a typical day you want to get at least 28-48 units of work done.
Some unit examples (more detail would be added)
Called Ruth to schedule appointment for qtr visit - 1 unit (designated who to bill to)
Travel to and from Ruth's house for qtr visit - 2 units
visit at Ruth's house - 6 units
Case note write up and qtr check list from visit - 2 units
Called meal site to rearrange hot/frozen meals - 1 unit
Adjusted medications for Ruth on assessment page - 1 unit
Copied lawyer information for Ruth per her request - 1 unit
Mailed lawyer information for Ruth - 1 unit

Time Units
15 minutes 1
30 minutes 2
45 minutes 3
60 minutes 4
1 hour 15 5
1 hour 30 6
1 hour 45 7
2 hours 8
2 hours 15 9
2 hours 30 10
2 hours 45 11
3 hours 12
3 hours 15 13
3 hours 30 14
3 hours 45 15
4 hours 16
So you can see how my career is ruled by units. The documentation is tedious at times but when you need to look back at the records to write a report it is easy to compile and remember.

What are Case Management Responsibilties? Karisha

So what exactly what do I do? Well here is a list of the responsibilities I have.

Case Management Responsibilities:
A. Assessing individual and determining need for service
B. Identifying all sources of funding services and supports
C. Developing Plan of Care
D. Ensuring use of Person Centered Planning
E. Reviewing and explaining to client services that will be provided
F. Supervising implementation of services for the client
G. Advocating on behalf of the clients’ interests
H. Monitoring the quality of HCBS and ensuring that POC objectives are being met
I. Determining cost effectiveness
J. Reassessing POC to determine need for continuation or termination of services
K. Performing record keeping and data collection activities
L. Ensuring confidentiality of individual information
M. Maintaining the highest professional and ethical standards
N. Reporting unusual occurrences or incidents

I will post later with examples how I do my job and how these responsibilities guide me.
Note: Some states require you to have a social work degree to be a case manager.